Effect of Donor-Recipient Age Difference on Living-Donor Lung Transplantation Outcomes

In living-donor lobar lung transplantation (LDLLT), significant donor-recipient age differences often occur because of the limited pool of related donors, typically parents or children, raising concerns regarding whether this affects postoperative outcomes and survival. In this study, we assessed the effect of living-donor and recipient age mismatch on LDLLT outcomes.

This retrospective cohort study included 82 patients who underwent bilateral LDLLT and 164 donors between October 1998 and October 2023. The donor-recipient pairs were categorized into 3 groups: an age difference of ≥20 years for both lungs, ≥20 years for 1 lung, and <20 years for both lungs. Postoperative outcomes, including survival and chronic lung allograft dysfunction (CLAD)-free survival, were compared between groups.

There were no significant differences in perioperative outcomes, including hospital mortality, 1-year survival, and acute rejection rates, across the different age-mismatch groups. Additionally, there was no clear correlation between age difference and the development of CLAD. Overall and CLAD-free survival rates were similar among the 3 groups, suggesting that donor-recipient age mismatch does not adversely affect long-term outcomes.

Within the limitations of this single-centre, retrospective cohort, we did not detect a significant association between donor-recipient age difference and perioperative, overall, or CLAD-free survival outcomes in LDLLT.